Northwest American Indians are a drastically understudied and underserved group, at risk for multiple health problems, in particular, cardiovascular disease. American Indians living in the Northwest have very high rates of diabetes, obesity, tobacco use, and other risk factors associated with cardiovascular disease. This application, in response to RFA HL-06-002, involves a 5-year developmental project to design and test a culturally appropriate, feasible, and generalizable cardiovascular disease risk prevention program for American Indians living in the Northwest. Building upon solid preliminary epidemiological and surveillance data as well as tribal support and an Indigenist stress-coping model, this study proposes five innovative and significant aims. First, we will conduct qualitative formative research involving 4 focus groups and 20, key informant interviews with parents aged 18-55 at risk for CVD, Native health providers, elder/traditional healers, and Native youth at long-term risk for CVD (aged 15-25). Second, we will conduct structured survey interviews with 375 American Indian adults randomly sampled from the Tulalip tribal rolls. With these interview data, we will test an indigenist stress coping model and establish preliminary baseline prevalence rates for self-reported CVD and its correlates with preliminary CVD and CVD risk-prevalence rates. Third, we will develop, manualize, and pilot test the feasibility, acceptability, and preliminary efficacy of a culturally-based 4-month CVD prevention intervention targeting adult American Indian parents at risk for CVD. Fourth, we will conduct a randomized control trial (RCT) of a multi-level motivational CVD intervention with 240 at-risk parents or caregivers of children under the age of 18 to evaluate its efficacy. We will also measure BMI on 480 children (age 5-18) whose parents or caregivers are in the RCT. Fifth, we will translate and disseminate the findings to the tribe as well as research outlets and the scientific community and prepare translational materials for community consumption and implementation. Through the course of the study, we aim to develop the research infrastructure at Tulalip Indian health clinic and to build the research capacity of the tribal community.